8.3 Breast Problems
Blocked (Plugged) Duct
Blocked ducts are a common occurrence for breastfeeding mothers at any stage of lactation. Milk ducts become blocked and distended and are palpable as a tender, small lump in the breast. The skin over the lump may be reddened and warm to touch.
Blockage may occur as a result of
- occlusion of a duct from pressure applied by an ill-fitting bra, a strap or clothing or mother compressing the breast during feeds
- excessive movement of the breasts such as running or aerobics
- poorly drained breast - mechanical causes of infant/mother, poor positioning or unfinished feeds
It has been noted that some mothers who experience repeated duct blockages have thicker milk, or the blockage may contain more fatty material than usual. 1 2 (Note: this should not be your first assumption - always investigate other causes first)
Management involves
- identification of the cause
- meticulous attention to position and latch
- warm compresses to the affected area or a soak in warm water prior to gentle, but firm massage
- massage the lump towards the nipple as the baby suckles, or when hand or pump expressing
- feed more frequently until lumps clears
- massage and hand expressing under a warm shower
If a blocked duct fails to be cleared it may progress to mastitis from the milk backed up; infective mastitis may follow.
Mastitis
Lactational mastitis most commonly occurs during the second and third weeks of the puerperium, either as a result of hospital management or the infective organism having been hospital-acquired 3 2however it may occur at any stage of lactation.
Aetiology
Mast -itis (inflammation of the breast) is a general term which encompasses different aetiology. The inflammatory process in lactational masitis is caused by either milk stasis or infection.
One author 4 found evidence that " without effective removal of milk, non-infectious mastitis was likely to progress to infectious mastitis... "
Milk stasis is non-infective, but may progress to an infective state if good clinical management is not implemented. Milk stasis is most commonly associated with:
- engorgement
- infrequent feeds, or scheduling the frequency and/or duration of feeds
- poor latching leading to inefficient removal of milk
- rapid weaning
- missing feeds, eg. overnight or because baby has received a bottle feed
- pressure on the breast (eg. tight bra, car seatbelt)
- a blocked nipple pore or duct
Associated factors which increase incidence of mastitis
- nipple damage - especially if colonised with Staphylococcus aureus
- illness in mother or baby
- oversupply of milk
- maternal stress or fatigue
- anaemia or malnutrition
Infection
- usually by a penicillin-resistant Staphylococcus aureus
- less commonly the organism is a streptococcus or Escherichia coli
(Sources: WHO 5 ABM protocols 6 )
Milk stasis and mastitis causes movement of sodium and chloride into the milk space 7 and milk supply will fall as synthesis temporarily slows in the affected area. The infant may fuss during breastfeeds as a result of these factors.
Preventing Mastitis
Educate mothers about the importance of good breastfeeding management, caring for themselves and their breasts.
- A well-latched baby who breastfeeds according to his needs will help to regulate the mother's milk supply and avoid nipple damage.
- Teach mothers to hand express to prevent engorgement.
- Encourage rest and a healthy diet to support her immune system.
- Encourage an awareness of breast lumps or areas of milk stasis and discuss treatment with massage, extra feeding, expressing and heat packs.
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() Be fore-armedWhilst we need to be very familiar with appropriate diagnosis and treatment of mastitis, prevention is a better approach.
During pregnancy, and as you educate mothers about effective breastfeeding, try not to focus your talk about mastitis in a way which will make mothers fear breastfeeding. Emphasise good position and latch, and effective breast drainage as the basis for all markers of good breastfeeding. Then the mother will understand that problems such as mastitis can be avoided - she can aim for success rather than presume that mastitis always comes with breastfeeding. | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() Workbook Activity 8.6Complete Activity 8.6 in your workbook. | ![]() |
Diagnosis
Diagnosis is usually made by clinical presentation.
- inflamed area of the breast
- a painful wedge-shaped lump
- associated with fever of 38.5ºC (101.3ºF) or greater, and
- chills, flu-like aching and systemic illness.
One researcher8 desribes her criteria for mastitis as "at least 2 breast symptoms (pain, redness or lump) AND at least one of fever or flu-like symptoms."
Laboratory cultures of the breastmilk are rarely performed unless it does not respond to classical management strategies, or the mother has repeated episodes.

© B.Ingle, IBCLC
Management
Knowing that milk stasis is the most common predisposing factor to mastitis, it stands to reason that the first management strategy will be to ensure frequent and effective milk drainage from the affected breast.
Effective milk removal
- measures to support return of milk supply
- ensure baby latching and suckling well. Observe the baby breastfeeding!
- warm breast soak or applying warm compresses prior to breastfeeding may help milk ejection
- massage the breast gently during the breastfeed
- review the frequency of breastfeeding; most babies will feed 6 to 18 times in 24 hours, and feeding should not be regulated by the mother 9
- hand expressing, or pumping after a breastfeed may be necessary
Supportive measures
- bed rest
- adequate fluids and nutrition
- practical help at home
- vitamin E-rich sunflower oil, echinacea and vitamin C supplements have been suggested to assist immune and inflammatory responses. 10
Pain relief
Researchers and clinicians have yet to conclude whether heat or cold is preferred, most suggesting both with heat being used prior to breastfeeding or expressing and cold afterwards.
-
Use of moist heat...
- soak a cloth in warm water and apply to affected breast
- immerse the breast in a container of warm water. Some mothers have obtained relief from putting magnesium sulphate (Epsom Salts) into the water.
- limit use of heat if significant inflammation is present
- Application of cold - either a chilled moist cloth or a covered ice pack.
Paracetamol (acetaminophen) and ibuprofen are both safe analgesics to use during lactation; paracetamol (acetaminophen) having better antipyretic properties, while ibuprofen has better anti-inflammatory properties.
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() Will weaning help?The mother may be planning to wean her baby - this is not the time to do it!
Weaning now (as tempting as it may seem) will increase milk stasis (and yes, begin to reduce milk supply), however the milk stasis increases the inflammatory response, further increasing risk of worsening mastitis and possible development of a breast abscess. It is important to clear the milk and allow the time for the breast to recover. | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() Workbook Activity 8.7Complete Activity 8.7 in your workbook. | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() Educational materialDevelop an information sheet to be discussed with mothers who have a blocked duct or mastitis, outlining the supportive measures they can take to facilitate a speedy recovery. This should be suitable for them to take home with them. | ![]() |
Complications
- reduced milk supply
- early weaning
- candida overgrowth
- breast abscess
What should I remember?
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]()
| ![]() |
Self-test quiz
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() |
Click and drag the missing words below into their correct place The missing words are: Staph antibiotic before blocked breastfeeds cold damaged drainage ducts express fever flu-like frequency infection inflammation inflammation lactational latch less lump massage position pressure rest stasis towards warm Mastitis is __________ of the breast. When it occurs during breastfeeding it is called __________ mastitis. This condition may have its origin from milk __________ or __________.Initially, __________ __________ may be the result of the milk stasis. The recommended management of this situation would include:
Milk stasis may be the result of externally applied __________ from tight bra or clothing. However, the main reason for milk stasis is ineffective __________ of the breast. This can be achieved by meticulous attention to __________ and __________ of the infant to the breast. If unresolved, milk forced into the tissues causes __________ and resultant further milk stasis. Infection with organisms such as __________ aureus is the most common cause of infective mastitis. A strong risk factor for infective mastitis is __________ nipples. The mother will display breast symptoms such as a red, inflamed area over the site of a hard __________ and the mother may also have a __________ and __________ symptoms. You can assist the mother to recover by suggesting supportive management such as __________, good fluid and nutritional intake. During this time, the most important management is frequent drainage of the breast - this can be achieved by:
| ![]() |
Notes
- # Eglash A (1998) Delayed milk ejection reflex and plugged duct. Lecithin therapy
- # Fetherston C (1998) Risk factors for lactation mastitis
- # Kinlay JR et al. (1998) Incidence of mastitis in breastfeeding women during the six months after delivery: a prospective cohort study
- # Thomsen AC et al. (1984) Course and treatment of milk stasis, noninfectious inflammation of the breast, and infectious mastitis in nursing women
- # World Health Organisation (2000) Mastitis: causes and management
- # Academy of Breastfeeding Medicine (2008) Clinical Protocol 4
- # Nguyen DA et al. (1998) Tight junction regulation in the mammary gland.
- # Amir LH et al. (2007) A descriptive study of mastitis in Australian breastfeeding women: incidence and determinants.
- # Kent JC et al. (2006) Volume and frequency of breastfeedings and fat content of breast milk throughout the day
- # Riordan J (2005) Breastfeeding and Human Lactation
- # World Health Organisation (WHO) (2001) The optimal duration of exclusive breastfeeding. Results of a WHO systematic review.
- # Saiman L et al. (2003) Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women